Cervical Cancer

Question 1

At what decade does cervical cancer peak?

Answer 1

The 6th decade.

Question 2

What are the 2 most common histological subtypes in cervical cancer?

(And which is most common)

Answer 2

Squamous cell cancer (80%)

Adenocracinoma (20%)

Question 3

What are some features of cervical cancer?

Answer 3

• Abnormal vaginal bleeding: postcoital, intermenstrual or postmenopausal bleeding.
• Vaginal discharge

Question 4

What are some risk factors for cervical cancer?

Answer 4

• Human papilloma virus (HPV) 16,18 & 33
• Smoking
• Human immunodeficiency virus
• Early first intercourse, many sexual partners
• High parity
• Lower socioeconomic status
• Combined oral contraceptive pill*

Question 5

How does HPV cause cervical cancer?

Answer 5

• HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
• E6 inhibits the p53 tumour suppressor gene
• E7 inhibits RB suppressor gene

Question 6

If a borderline or mild dyskaryosis is seen, what is done next?

Answer 6

The original sample is tested for HPV (16,18 and 33).

• If negative the patient goes back to routine recall.
• If positive the patient is referred for colposcopy

Question 7

What do you do if a patient has moderate dyskaryosis (CIN II) after a cervical smear?

Answer 7

Refer for colposcopy

Question 8

What do you do if a patient is has severe dyskaryosis (Consitent with CIN III) after a cervical smear?

Answer 8

Refer for colposcopy

Question 9

What do you do if a patient is has suspected invasive cancer on cervical screening.

Answer 9

Refer for urgent colposcopy (within 2 weeks)

Question 10

If a cervical smear is inadequate, what should be done?

Answer 10

• Repeat the smear -
  
  • if persistent (3 inadeqaute samples) then assess by colposcopy.

Question 11

Describe cervical cancer screening in the UK.

Answer 11

• A smear test is offered to all women between the ages of 25-64 years
• 25-49 years: 3-yearly screening
• 50-64 years: 5-yearly screening

Question 12

When is the best time to do a cervical smear?

Answer 12

Mid-cycle

Question 13

Why is liquid based cytology used now instead of pap-smears?

Answer 13

• reduced rate of inadequate smears
• Greater sensitivity and specificity

Question 14

What subtype of cervical cancer does cervical cancer screening detect?

Answer 14

Squamous cell carcinoma

And thus adenocarcinoma can be missed.

Question 15

Liquid based cytology reduces the rate of inadequate smears and has better sensitivity and specificity than smears. BUT have they increased the detection cervical adenocarcinoma?

Answer 15

Nope. It doesn’t detect adenocarcinoma only Squamous Cell Carcinoma.

Question 16

Which HPV Virus causes Cervical cancer and which causes genital warts?

Answer 16

Cervical Cancer = HPV 16,18 & 33

Genital Warts HPV = 6 & 11 (90%) of cases